How does a successful disease management program work?
Research-based guidelines are at the core of successful disease management. Simply put, they are recommended standards of treatment based on scientific evidence. The Federal Agency for Healthcare Research and Quality works with many groups that collect existing research on treatments for medical conditions, rate the quality of the research and report the accumulated scientific findings. That information is used by other professionals to develop guidelines.
Health care providers improve quality not only by practicing evidence-based medicine but also by reporting their results with patients and contributing to research. In that way, quality begets more quality.
What role do employers and health insurers play in disease management programs?
Health insurers must continue their leadership role in driving quality up and costs down. Employers who partner with health plans that have disease-management expertise make an investment in the health of their employees.
To determine how strong a partner your health insurer is, look for features such as:
- Intervention: This ranges from reminders about required care for high-risk patients to enrolling patients with chronic diseases into disease-management programs.
- Coverage of health screenings: These can detect disease early and include colonoscopies, Pap tests, mammograms, and cholesterol screenings. The tests must be affordable.
- Patient education: Such efforts teach high-risk patients how to minimize their risk of disease by changing risky health behaviors. The plan should provide tools for change, such as interactive Web sites and low-cost or no-cost health education opportunities.
- Workplace education: The plan should provide onsite health education targeted to the health needs of employees, include a health-risk assessment tool for employees to learn about their risk factors and conduct health screenings at the worksite.
- Research-based guidelines: The plan should work to discover the most effective preventive measures and treatments, and these should be communicated to and followed by all plan providers.
- Quality measurement: The health plan’s clinical guidelines should translate into better health for plan members.
What can employers do to determine if disease management is right for them?
Employers should ask themselves, ‘Am I concerned with health care value, not just costs? Am I attentive to how I can improve my employees’ health while they’re on the job? What about during their off-hours? Am I willing to invest in long-term benefits?’
If you answer yes, you are joining the list of employers seeking to lower insurance costs and produce a more productive work force through disease management.
Dr. John Wallendjack is vice president of Medical Affairs for HealthAmerica. Reach him at [email protected].
